Assessment of Complications After Pancreatic Surgery

DeOliveira, Michelle L.; Winter, Jordan M.; Schäfer, Markus; Cunningham, Steven C.; Cameron, John L.; Yeo, Charles J.; Clavien, Pierre Alain

doi:10.1097/01.sla.0000246856.03918.9a

Cited by 690 publications

(232 citation statements)

References 33 publications

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“…Recent efforts have attempted to clarify this and apply a grading system of complications in pancreatic surgery [26,29]. The ISGPS found that several definitions for DGE, POPF and PPH already existed and the study group recently standardised these definitions [22,23,24].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Surgical Outcome Scores according to ISGPS Definitions in Patients Undergoing Pancreatic Resection

et al. 2010

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Aims: To evaluate the role of the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), the Portsmouth variant (p-POSSUM) and the Glasgow Prognostic Score (GPS) in predicting outcome after pancreatic surgery with reference to the International Study Group of Pancreatic Surgery (ISGPS) definitions of post-pancreatectomy complications. Methods: All consecutive patients undergoing major pancreatic resection over a 32- month period were included. POSSUM, p-POSSUM and GPS score were calculated for each patient and correlated against the observed mortality and morbidity using the ISGPS definitions. Results: The observed:expected ratios for POSSUM mortality, POSSUM morbidity and p-POSSUM mortality were 0.24 (p < 0.0001), 0.86 (p < 0.0001) and 0.79 (p = 0.09), respectively. POSSUM had a ‘poor fit’ with respect to predicting morbidity (χ² = 16.4, 8 d.f., p = 0.04). Multifactorial regression analysis revealed the GPS as an independent predictor of post-operative outcome (GPS 1, p = 0.03, OR 2.99, 95% CI 1.4–7.9, and GPS 2, p = 0.02, OR 4.3, 95% CI 1.8–15.5). Conclusion: POSSUM has a limited role as an outcome score in pancreatic resection. The GPS may be a novel alternative to POSSUM as a pre-operative predictor of outcome.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Surgical Outcome Scores according to ISGPS Definitions in Patients Undergoing Pancreatic Resection

et al. 2010

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“…Oncology surgery of the gastrointestinal tract is known for its high complication rates [1,2,3,4]. It usually involves extensive and complex surgery.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Lemmens

Zelm²,

Rinkes

et al. 2009

Dig Surg

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Background/Aims: Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients’ condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the interventions of clinical pathways for digestive surgery and their effects on postoperative outcome measures. Methods: We performed a systematic review to study clinical pathways in hospital care for adult patients undergoing elective surgery of the stomach, esophagus, pancreas, liver, colon or rectum. The MEDLINE, EMBASE and CINAHL literature databases were searched. Results: The most common interventions in the clinical pathways in this review were defined in the pre- and postoperative phase and included: nutritional management, pain management, mobilization, education and discharge planning. The primary aim of these interventions was to enhance postoperative recovery. Conclusion: Clinical pathways for digestive surgery contain specific interventions to improve postoperative outcome. Most of these interventions are in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, which is an evidence-based protocol for care after colon resections. They result in reduced length of stay without compromising other postoperative outcome measures.

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“…Although this technique was associated with lower rates of postoperative fistula than PJ, this surgical technique is not easy to reproduce and might not always be possible for oncological reasons [56] . This complexity may explain why gastric partitioning with preservation of the pylorus and PF appears in 3%-30% of patients [1,41,50,51] . It must be suspected when the amylase content of drained fluid is more than 3 times the normal value in the third postoperative day.…”

Section: Definition Of Pancreatic Fistulamentioning

confidence: 99%

“…Basically, three types of PG have been described: (1) in classic duct-to-mucosa anastomosis the pancreatic stump is sutured to the seromuscular layer of the gastric wall, while the MPD is sutured to the full-thickness stomach [32] , with or without a lost pancreatic stent; (2) in pancreatic stump intussusception into the stomach, the distance between the surface of the stump and the suture is longer, thus decreasing the risk of a fistula between the stitches that cross the pancreatic capsule. Suturing can be performed from the posterior gastric surface or from the inside of the gastric cavity through an anterior gastrostomy [33] .…”

Section: Types Of Pancreatogastrostomiesmentioning

confidence: 99%

“…Pancreatic surgeons try to find the best technique of reconstruction after pancreatoduodenectomy (PD) in order to decrease the frequency and seriousness of postoperative complications, mainly pancreatic fistulas (PF) [1] . The aim of this work was to compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG) in order to determine which of the two is better.…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

Gómez¹

2014

WJGO

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Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy (PD) in order to decrease postoperative complications, mainly pancreatic fistulas (PF). In this work, we compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), in order to determine which of the two is better. A systematic review of the literature was performed, including major meta-analysis articles, clinical randomized trials, systematic reviews, and retrospective studies. A total of 64 articles were finally included. PJ and PG are usually responsible for most of the postoperative morbidity, mainly due to the onset of PF, being considered a major trigger of life-threatening complications such as intra-abdominal abscess and hemorrhagia. The included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring PG. PF, delayed gastric emptying and mortality were not different. Although there was heterogeneity between these studies, all were conducted in specialized centers by highly experienced surgeons, and the surgical care was likely to be similar for all the studies. The disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric mucosa. Exocrine function appears to be worse after PG than after PJ, resulting in severe atrophic changes in the remnant pancreas. Depending on the type of PJ or PG used, the PF rate and other complications can also be different. The best method to deal with the pancreatic stump after PD remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and visualization. In conclusion, up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD. Core tip: Pancreatoduodenectomy is a technique with a high rate of morbidity and mortality. Surgeons try to find the best technique of reconstruction in order to decrease postoperative complications. We compare the two most frequent techniques of reconstruction after pancreatoduodenectomy, namely pancreatojejunostomy and pancreatogastrostomy, to determine which of the two is better. We offer a systematic review of the main papers published with all the pros and cons of each technique. The best method to deal with the pancreatic stump after pancreatoduodenectomy remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles, such as good exposure and visualization. TOPIC HIGHLIGHTSeptember 15, 2014|Volume 6|Issue 9|

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Assessment of Complications After Pancreatic Surgery

Cited by 690 publications

References 33 publications

Evaluation of Surgical Outcome Scores according to ISGPS Definitions in Patients Undergoing Pancreatic Resection

Evaluation of Surgical Outcome Scores according to ISGPS Definitions in Patients Undergoing Pancreatic Resection

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

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